The Shadow Practice: Medical Board Waits Years to Catch Up with DEA

What does it take to get the attention of the U.S. Drug Enforcement Administration?

Selling truckloads of methamphetamine while working for the Aryan Brotherhood?

Labeling drugs with comic book characters and selling them to kids?

How about prescribing so many painkillers that you surpass your annual limit?

That’s what did it for Dr. Harrell Robinson back in 2009.

The Madre Maria Ines Teresa Health Center in Santa Ana, Calif., paid Robinson $10,000 a month for the use of his DEA registration to order painkillers from a wholesale supplier, DEA records show. When he reached his limit, Robinson started paying Dr. Scott Bickman, a Los Angeles anesthesiologist, $2,000 a month to use his DEA registration.

In 2007, Robinson was one of the largest California purchasers of hydrocodone, according to the DEA. In 2008, Bickman was one of the largest.

Initially, the DEA didn’t seem to think that Bickman’s role in this arrangement was a big deal.

In 2009, the agency stripped Robinson of his ability to continue to prescribe painkillers and other drugs regulated by the agency. The Medical Board of California took his physician’s license away the same year.

But Bickman continued to work with no restrictions. This had a perverse effect. Because the medical board had done nothing to Bickman’s license – other than putting him on probation following a patient death in 2001 – Bickman nearly escaped discipline by the DEA. Here’s what I wrote previously:

The federal case against Bickman went before an administrative law judge and the judge weighed the medical board's inaction in Bickman's favor. The filing says that the judge took note that Bickman's California license "is unrestricted and that he is authorized to handle controlled substances," a situation that supported the idea that "continued registration would be in the public interest."

Then the judge weighed other factors against Bickman, finding that he "knew or should have known that'' his registration was being used "to order controlled substances that were likely to be diverted." The judge also said that Bickman's "refusal to acknowledge his wrongdoing offers little hope for the prospect that if he retains his DEA registration he will act more responsibly in the future."

Bickman told me in an interview that the wholesale drug company – the Harvard Drug Group -- was the real culprit and that Robinson had taken advantage of him. I asked him, “But don't you have to admit that it seems odd that you would voluntarily give someone your DEA registration information when, as you have said, you didn't trust him, and then never follow-up to see what sort of drugs he was ordering with it?” Here’s what he said:

But when I started working there I had to provide him my credentials. So he already had them. And then his wife became involved, and so she had access to them, too. While I was at the office, I was friends with the secretary who was in the front. We became pretty friendly actually. She used my DEA registration to order drugs from three different companies, but none of those companies ever verified with me that it was OK with me. I had never prescribed anything for anyone in my entire lifetime, and now I was all of a sudden supposedly ordering all these drugs. Something should have tipped them off that this was unusual. And everybody always wants to leave 2007 out of, but you have to look at what was happening in 2007. You accurately report that in the latter part of 2007 Robinson was reaching his limits and Harvard told him that. Harvard also says that it was notifying the DEA about that. Robinson was a known felon and was a known person who had been convicted of insurance fraud. If Harvard was notifying the DEA, why weren't they flying out to California and having him prove the documentation for all the drugs he had been ordering? The Harvard compliance officer should have done that. The DEA should have done that. But, instead, they just sat and waited. And so I ended up being taken advantage of. There's a responsibility factor here. They knew all of this and did nothing to stop him.

Bickman made a great point about the Harvard Drug Group, and I wrote last year about how its business model seemed to encourage diversion of addictive drugs for non-medical purposes. The DEA fined the company in April 2011 for its role in another pill mill case.

That same month, two years after the agency took Robinson’s registration away, the DEA took action against Bickman. In its filing, the DEA summed things up this way:

[Bickman] authorized Robinson to use his registration and then did nothing to determine how it was being used. He did not go to the clinic to see whether Robinson was maintaining records for even those drugs which would be used to provide anesthesia, or to see whether Robinson was, in fact, still performing surgery after the clinic lost its accreditation and could no longer legally do so. Thus, I conclude that [Bickman's] assertion that he was not "okay" with what happened is simply a case of crying crocodile tears. Because [Bickman] has not accepted responsibility for his misconduct and that misconduct manifests an egregious disregard for his responsibilities as a DEA registrant, I hold that [Bickman] has not rebutted the Government's prima facie showing that his continued registration is ‘inconsistent with the public interest.'

I assumed that the Medical Board would take action shortly after the federal agency. But the board did nothing. This begs the same question: What does it take to get the attention of the Medical Board of California?

To Bickman, the board’s inaction was more proof of his innocence. He told me:

Why do you think the medical board didn't do an investigation into this? They took [Robinson’s] license away on nine of 10 counts. They haven't done anything to my license. They said he paid me money to be medical director. They specifically do not say that I sold him my license. If the medical board thought I had done something wrong, why wouldn't they have done something about it?

Now, it seems, the Medical Board is changing course. As part of its new set of charges against Bickman, the Medical Board has listed its “fifth cause of discipline” as “action by federal agency.” The board also refers to the DEA case in its “sixth cause of discipline,” which is “knowingly make false documents/dishonesty or corruption.”

In the Medical Board documents, the board summarizes the DEA case this way:

The Order to Show Cause alleged, among other things, that from December 2007 through October 2008, [Bickman] allowed his DEA registration to be used to purchase at least 281,500 dosage units of hydrocodone combination products, in exchange for $2,000 per month. The Show Cause Order also alleged that [Bickman] materially falsified his July 25, 2008, application to renew his registration because he failed to disclose that the Medical Board of California had placed limits on his practice and placed him on probation for a period of thirty-five (35) months, effective September 18, 2006. The order revoked [Bickman’s] DEA Certificate of Registration, BB2698632, effective April 29, 2011 (DEA Order.)

The Medical Board has other charges it is bringing to the table, too. I wrote on Monday about a case in which a patient undergoing surgery nearly died on the operating table. I’ll write next week about how Bickman’s prescribing patterns for a family member caught the Medical Board’s eye.

Image by Johnathan Silverberg via Flickr